Pacific Northwest Newspaper Guild
Secure Signature Portal
Anchorage Daily News
Company
This field is for validation purposes and should be left unchanged.
This is a written assignment and authorization agreement for deduction from wages under Alaska law (8 AAC 15.160).
I hereby assign to the Pacific Northwest Newspaper Guild, TNG-CWA # 37082 (“Union”), and authorize and agree to have Anchorage Daily News (“Employer”) deduct from any salary earned or to be earned by me as an employee, an amount equal to 1.5% of my gross straight-time wages for payment of Union Dues. I authorize and agree that Anchorage Daily News will withhold and remit Union Dues to the Union on my behalf on a quarterly basis with dues being withheld each month and remitted to the Union on or before the third Friday of the month following the quarter end.
This assignment and authorization agreement only applies to Union Dues as described and does not cover any other payments owed by me to the Union such as initiation fees, assessments, fines, or other payments. This assignment and authorization agreement to deduct begins the first payroll period following the Employer’s receipt of this authorization agreement.
This assignment and authorization agreement will remain in effect until revoked by me which I may do in my sole discretion at any time after one year from signing this authorization, or my employment with Employer is terminated, or the contract is terminated, but will be irrevocable for a period of one year from the date appearing below.
I further agree and direct that this assignment and authorization will be continued automatically after one year subject to the understanding that I may revoke it at any time after one year from signing this authorization. Such notice of revocation shall become effective for the calendar month following the calendar month in which Employer receives it.
I understand I may elect to pay Union Dues on my own by arrangement with my financial institution and the Union in which case I will advise Anchorage Daily News so that my dues are not also withheld and remitted by Anchorage Daily News.
If I have any questions, it is my responsibility to bring those to the attention of the Anchorage Daily News and/or the Union. This assignment and authorization agreement to deduct Union Dues is voluntarily made to pay my equal share of the Union’s costs of operation and is not conditioned on my present or future membership in the Union.
This assignment and authorization agreement supersedes all previous assignments and authorizations given by me in relation to Union Dues.
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Phone
(Required)
Gender
(Required)
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond
Home Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Employer
(Required)
Date of Hire
(Required)
Month
Day
Year
Work Phone
(Required)
Department in Which Employed
(Required)
Job Title
(Required)
Membership Agreement
Designation Agreement
(Required)
I designate Pacific Northwest Newspaper Guild, Local 37082 as my collective bargaining representative, and to represent me before any Board, Court, Committee or other tribunal in any matter involving collective bargaining. I authorize Pacific Northwest Newspaper Guild, Local 37082 to represent me in adjusting any grievances I may have in connection with my employment.
Authorization
(Required)
I have read and agree to the terms and conditions, confirm the accuracy of the information provided, and consent to the processing of my data for the purpose stated. By checking this box, I acknowledge that I am the person completing and signing this form.
Signature
(Required)
Today's Date
(Required)
